Healthcare Provider Details

I. General information

NPI: 1730483058
Provider Name (Legal Business Name): TAG-2 MEDICAL INVESTMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S MARENGO AVE
ALHAMBRA CA
91803-3055
US

IV. Provider business mailing address

1668 S GARFIELD AVE FL 2
ALHAMBRA CA
91801-5400
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-1032
  • Fax:
Mailing address:
  • Phone: 626-943-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH T SIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-943-6298